CHAIN Case Study

A 71 years old man presenting with hip osteoarthritis, with a complex range of comorbidities was referred by his GP to CHAIN.

Many clinicians would have questioned the man’s suitability for the programme due to his co-existing medical conditions. This case study shows that patients may be much more able than we think to achieve significant improvement with exercise.

The patient, although presenting with complex comorbidities, benefitted greatly from taking part in the CHAIN programme, and his significant progress made throughout the programme had a positive impact on the rest of the group. Improvements were seen in the Oxford Hip Score, HOOS Function Score, Sit to stand test, Timed up and go test, pain scores and hip flexion. There was also a weight loss (see Table 1).

Before

After

Change

Oxford Hip Score

16.0

21.0

5.0

EQ5D VAS

80.0

65.0

-15.0

HOOS Function Score

13.2

44.1

30.9

Sit to Stand

18.1

16.6

1.5

Timed up and go (s)

36.5

10.9

25.6

Pain at rest

3.3

2.3

-1.0

Pain weight bearing

3.8

2.0

-1.8

Flexion (degrees)

80.0

95.0

15.0

Weight (kg)

87.8

85.7

-2.1

The man reported an “amazing difference” in the improvement in the strength and use of his right leg. He also reported an improvement in his physiological welfare and fitness as he was able to cope better in the heat, and needed to rest less. However, he wasn’t able to use his walking stick less owing to existing numbness in his feet and lower limbs. Six weeks after the programme the man was cycling around town for at least 15 minutes a day, and he continues to cycle and walk his dogs as he finds this helps with the hip pain.